Real-World Barriers and Opportunities for Cell and Gene Therapy (CGT): An Analysis of US Hematologist and Oncologist Insights on Readiness and Access

Cell and gene therapies (CGTs) are rapidly transforming the hematologic malignancy treatment landscape. Despite their promise, real-world adoption and access remain limited, particularly outside academic medical centers (AMCs). This analysis aimed to characterize physician real-world insights, barriers, and readiness for CGT delivery across diverse US practice settings. A double-blind, online survey was conducted from June to July 2025, sampling board-certified US hematologists and oncologists with direct experience in CGT treatment or referral. Respondents represented AMCs and community hospitals/clinics. Survey topics included access, barriers, institutional readiness, patient and physician attitudes, and future outlook. Data were analyzed by subgroup to identify key trends and consensus areas among providers. The survey included 126 US hematologists and oncologists, 64% identified as treaters and 36% as referrers. Physicians managed an average of 25 patients with CGT per year. Nearly all agreed that CGTs are among the most important medical innovations, with readiness to embrace CGT innovations higher in AMCs than in community settings. Most (61%) respondents reported that patients referred for CGT often do not receive therapy, primarily due to insurance coverage and cost burden. Financial constraints, lack of trained staff, and insufficient resources were cited as the most significant barriers limiting CGT delivery. Accreditation requirements were more frequently cited as a barrier to increasing CGT access by community (20%) than AMC (8%) physicians. Additionally, 47% of community respondents agreed making it easier to become a qualified treatment center is a priority for improving access. A degree of uncertainty was observed, with 65% of physicians viewing CGTs as promising but largely unproven and 66% noting increased patient concerns about CGTs being experimental or risky. The need for convincing durability data was cited as the top challenge to expanding access. Most (79%) respondents agreed that the US healthcare system is incompatible with high-cost CGTs, and innovative payment models were widely viewed as essential for broader adoption. Looking ahead, 60% of participants expect CGTs to become widely accessible within 5 –10 years, with most anticipating that administration will remain concentrated in AMCs and community hospitals as CGTs expand to larger indications. Physicians recognize the transformative potential of CGTs but highlight persistent barriers in access, infrastructure, and evidence. Addressing financial constraints, expanding workforce training, and developing innovative payment models are critical for broader adoption. Real-world durability data and streamlined qualification for treatment centers are top priorities to enable sustainable CGT access, especially in community settings.